<div class="page-header">
    <h1>
        Form Update Kontak
        <small>
            <i class="icon-double-angle-right"></i>
            Update data kontak member
        </small>
    </h1>
</div>

<?php
if ($this->msg) {
    ?>
    <div class="alert alert-danger">
        <button type="button" class="close" data-dismiss="alert">
            <i class="icon-remove"></i>
        </button>

        <strong>
            <i class="icon-remove"></i>
            Error
        </strong>

        <?php echo $this->msg; ?>
        <br />
    </div>
    <?php
}
    ?>

    <div class="row">
        <div class="col-xs-11">
            <form id="formAdd" class="form-horizontal" role="form" action="" method="post">
                
                <div class="form-group">
                    <label class="col-sm-2 control-label no-padding-right" for="bank_id"> Nama Kontak </label>

                    <div class="col-sm-9">
                            <input type="hidden" id="contact_id" name="contact_id" value="<?php if (isset($this->data['contact_id'])) { echo $this->data['contact_id']; } ?>"/>
                            <input type="text" id="contact_name" name="contact_name" placeholder="Nama Kontak" class="col-xs-10 col-sm-5" value="<?php if (isset( $this->data['contact_name'] )) { echo $this->data['contact_name'];} ?>" required />
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label no-padding-right" for="bank_acc_name">Tlp </label>
                    <div class="col-sm-9">
                        <input type="text" id="contact_phone" name="contact_phone" placeholder="Tlp" class="col-xs-10 col-sm-5" value="<?php if (isset( $this->data['contact_phone'] )) { echo $this->data['contact_phone'];} ?>" required />
                </div>

            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="bank_acc_no"> Email </label>

                <div class="col-sm-9">
                    <input type="text" id="contact_email" name="contact_email" placeholder="Email" class="col-xs-10 col-sm-5" value="<?php if (isset( $this->data['contact_email'] )) { echo $this->data['contact_email'];} ?>" required />
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="name"> HP </label>

                <div class="col-sm-9">
                    <input type="text" id="contact_mobile" name="contact_mobile" placeholder="HP" class="col-xs-10 col-sm-5" value="<?php if (isset($this->data['contact_mobile'])) { echo $this->data['contact_mobile']; } ?>" required />
                </div>
            </div>
                <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="name"> Alamat </label>

                <div class="col-sm-9">
                    <input type="text" id="contact_address" name="contact_address" placeholder="Alamat" class="col-xs-10 col-sm-5" value="<?php if (isset($this->data['contact_address'])) { echo $this->data['contact_address']; } ?>" required />
                </div>
            </div>
                <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="name"> Kota </label>

                <div class="col-sm-9">
                    <input type="text" id="contact_city" name="contact_city" placeholder="Kota" class="col-xs-10 col-sm-5" value="<?php if (isset($this->data['contact_city'])) { echo $this->data['contact_city']; } ?>" required />
                </div>
            </div>
                <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="name"> Provinsi </label>

                <div class="col-sm-9">
                    <input type="text" id="contact_province" name="contact_province" placeholder="Provinsi" class="col-xs-10 col-sm-5" value="<?php if (isset($this->data['contact_province'])) { echo $this->data['contact_province']; } ?>" required />
                </div>
            </div>
            <div class="form-group">
                    <label class="col-sm-2 control-label no-padding-right" for="bank_id"> Negara </label>

                    <div class="col-sm-9">
                            <select class="width-30 chosen-select" id="country_id" name="country_id">
                                <option value="1">Indonesia</option>
                                
                        </select>
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label no-padding-right" for="name"> Kode Pos </label>

                    <div class="col-sm-9">
                        <input type="text" id="post_code" name="post_code" placeholder="Kode Pos" class="col-xs-10 col-sm-5" value="<?php if (isset($this->data['post_code'])) { echo $this->data['post_code']; } ?>" required />
                    </div>
                </div>
            <div class="clearfix form-actions">
                <div class="col-md-offset-3 col-md-9">
                    <button class="btn btn-info" type="submit">
                        <i class="icon-ok bigger-110"></i>
                        Submit
                    </button>

                    &nbsp; &nbsp; &nbsp;
                    <button class="btn" type="reset">
                        <i class="icon-undo bigger-110"></i>
                        Reset
                    </button>
                </div>
            </div>
        </form>
    </div>
</div>
